Diabetes Prevention Culturally Tailored for Mexican Americans

摘要 斯塔尔县是一个贫穷的德克萨斯州和墨西哥边境社区，98%是墨西哥裔美国人， 得克萨斯州糖尿病相关死亡率。在斯塔尔县之前的研究中，我们测试了文化干预 专为说西班牙语的墨西哥裔美国人量身定做，诊断为2型糖尿病(T2 DM)。每项研究 参与者得到了一名家庭成员的支持，该成员也获得了计划福利；其中70%的支持者 没有患糖尿病。与对照组相比，实验中的非糖尿病支持者较少 组在研究开始后12个月转为糖尿病。拟议研究的主要目的是 测试我们为文化量身定制的DSME干预措施的有效性，这些干预措施将适用于预防或 最小的延迟，糖尿病前期墨西哥裔美国人的糖尿病发病。干预措施将包括：1)12 2- 每周一小时的小组教育课程，强调饮食和准备健康的墨西哥裔美国人 食物和增加体力活动；2)15个两周/每月两小时的问题支持小组会议 解决采用更健康的生活方式的障碍；以及3)每隔6个月举行3次助推会。我们 将结合糖尿病预防计划的各个方面，以及激励性访谈，并在 干预测试，我们将与斯塔尔县的关键人员进行重点小组讨论，以确认该策略 并获得社区的支持。干预效果将使用随机、重复的 措施，前测/后测控制组设计，具有“增强的”日常护理控制组。我们将招收 300名墨西哥裔美国人从正在进行的斯塔尔县基因研究名单中确诊为糖尿病前期患者。 10人为一组，按所在县的面积分组，每组 随机分配到实验或控制条件。使用多水平模型的增长曲线分析将 用于比较一段时间内对健康结果的干预效果。我们假设参与者在 与对照组相比，试验组将有更好的健康结果(A1C，FBG，血脂， 血压、体力活动、饮食摄入量和人体测量变量[BMI，腰围])在3，6，12，24， 基线后36个月，以及36个月后转为T2 DM(OGTT)的比率较低。本研究 是我们为高收入人群制定有效的文化定制健康计划的重要一步 2型糖尿病的风险。

ABSTRACT Starr County is a poor Texas-Mexico border community that is 98% Mexican American and has the highest diabetes-related death rate in Texas. In previous Starr County studies, we tested interventions culturally tailored for Spanish-speaking Mexican Americans diagnosed with type 2 diabetes (T2DM). Each study participant was supported by a family member who also received program benefits; 70% of these supporters did not have diabetes. Compared to the control group, fewer non-diabetic supporters in the experimental group converted to diabetes by 12 months post study entry. The primary purpose of the proposed study is to test the effectiveness of our culturally tailored DSME intervention that will be adapted for preventing, or at least delaying, diabetes onset in Mexican Americans with prediabetes. The intervention will involve: 1) 12 2- hour weekly group educational sessions that emphasize eating and preparing healthy Mexican-American foods and increasing physical activity; 2) 15 2-hour bi-weekly/monthly support group sessions on problem solving the barriers to adopting healthier lifestyles; and 3) 3 booster sessions held at 6-month intervals. We will integrate aspects of the Diabetes Prevention Program, as well as motivational interviewing, and prior to intervention testing, we will conduct focus groups with key individuals in Starr County to confirm the strategy and obtain community support. Intervention effectiveness will be examined using a randomized, repeated measures, pretest/posttest control group design, with an “enhanced” usual care control group. We will enroll 300 Mexican Americans with verified prediabetes from rosters of ongoing Starr County genetic studies. Groups of 10 will be constituted according to the area of the county in which people live; each group will be randomly assigned to experimental or control conditions. Growth curve analysis, using multilevel models, will be used to compare intervention effects on health outcomes over time. We hypothesize that participants in the experimental group, compared to the control group, will have better health outcomes (A1C, FBG, lipids, BP, physical activity, dietary intake, and anthropometric variables [BMI, waist circumference]) at 3, 6, 12, 24, and 36 months post baseline, as well as lower rates of converting to T2DM (OGTT) by 36 months. This study is a significant step in our plan to develop effective culturally tailored health programs for populations at high risk for T2DM.